First Nations Peoples' perceptions, knowledge and beliefs regarding stillbirth prevention and bereavement practices: A mixed methods systematic review

BACKGROUND

First Nations Peoples endure disproportionate rates of stillbirth compared with non-First Nations Peoples. Previous interventions have aimed at reducing stillbirth in First Nations Peoples and providing better bereavement care without necessarily understanding the perceptions, knowledge and beliefs that could influence the design of the intervention and implementation.

AIM

The aim of this review was to understand the perceptions, knowledge and beliefs about stillbirth prevention and bereavement of First Nations Peoples from the US, Canada, Aotearoa/New Zealand, and Australia.

METHODS

This review was conducted in accordance with the JBI methodology for a convergent integrated mixed method systematic review. This review was overseen by an advisory board of Aboriginal Elders, researchers, and clinicians. A search of eight databases (PubMed, MEDLINE, PsycInfo, CINAHL, Embase, Emcare, Dissertations and Theses and Indigenous Health InfoNet) and grey literature was conducted. All studies were screened, extracted, and appraised for quality by two reviewers and results were categorised, and narratively summarised.

RESULTS

Ten studies were included within this review. Their findings were summarised into four categories: safeguarding baby, traditional practices of birthing and grieving, bereavement photography and post-mortem examination. The results indicate a diversity of perceptions, knowledge and beliefs primarily around smoking cessation and bereavement practices after stillbirth. However, there was a paucity of research available.

CONCLUSIONS

Further research is needed to understand the perceptions, knowledge and beliefs about stillbirth among First Nations Peoples. Without research within this area, interventions to prevent stillbirth and support bereaved parents and their communities after stillbirth may face barriers to implementation.

First Nations populations' perceptions, knowledge, attitudes, beliefs, and myths about prevention and bereavement in stillbirth: a mixed methods systematic review protocol

OBJECTIVE

The objective of this review is to investigate First Nations populations' perceptions, knowledge, attitudes, beliefs, and myths about stillbirth.

INTRODUCTION

First Nations populations experience disproportionate rates of stillbirth compared with non-First Nations populations. There has been a surge of interventions aimed at reducing stillbirth and providing better bereavement care, but these are not necessarily appropriate for First Nations populations. As a first step toward developing appropriate interventions for these populations, this review will examine current perceptions, knowledge, attitudes, beliefs, and myths about stillbirth held by First Nations people from the United States, Canada, Aotearoa/New Zealand, and Australia.

INCLUSION CRITERIA

The review will consider studies that include individuals of any age (bereaved or non-bereaved) who identify as belonging to First Nations populations. Eligible studies will include the perceptions, knowledge, attitudes, beliefs, and myths about stillbirth among First Nations populations.

METHODS

This review will follow the JBI methodology for convergent mixed methods systematic reviews. The review is supported by an advisory panel of Aboriginal elders, lived-experience stillbirth researchers, Aboriginal researchers, and clinicians. PubMed, MEDLINE (Ovid), CINAHL (EBSCOhost), Embase (Ovid), Emcare (Ovid), PsycINFO (EBSCOhost), Indigenous Health InfoNet, Trove, Informit, and ProQuest Dissertations and Theses will be searched for relevant information. Titles and abstracts of potential studies will be screened and examined for eligibility. After critical appraisal, quantitative and qualitative data will be extracted from included studies, with the former "qualitized" and the data undergoing a convergent integrated approach.

REVIEW REGISTRATION

PROSPERO CRD42023379627.

The impact of cytokines on the expression of drug transporters, cytochrome P450 enzymes and chemokine receptors in human PBMC

BACKGROUND AND PURPOSE

The function of transporters in peripheral blood mononuclear cells (PBMC) has been characterized, but less is known about cytochrome P450 (CYP) enzyme function in these cells. Given that cytokines are dysregulated in many diseases, the purpose of this work was to assess the impact of cytokines on the expression of CYPs, transporters and chemokine receptors in PBMC.

EXPERIMENTAL APPROACH

Human PBMC were incubated with cytokines for 48 h. ATP-binding cassette (ABC)B1, ABCC1, ABCC2, CYP2B6, CYP3A4, CXCR4 and CCR5 expression were measured by quantitative polymerase chain reaction and flow cytometry at 0, 4, 8, 24 and 48 h. Enzyme activity was assessed using fluorescent probes.

KEY RESULTS

We show here functional activity of CYP3A4 and CYP2B6 in PBMC. Furthermore, cytokines had a significant impact on the mRNA and protein expression of all proteins. For example, interleukin-2 (IL-2) had a marked impact on ABCB1 mRNA (% control 4745 +/- 11961) and protein (% control 200 +/- 57). Increases in drug efflux transporter expression, in response to cytokines, resulted in reduced cellular accumulation of digoxin [decrease of 17% and 26% for IL-2 and interferon-gamma (IFNgamma) respectively] and saquinavir (decrease of 28% and 30% for IL-2 and IFNgamma respectively). The degree to which drug transporter and chemokine receptor expression changed in response to cytokines was positively correlated (e.g. ABCB1 and CXCR4, r(2) = 0.545).

CONCLUSIONS AND IMPLICATIONS

These data have important implications for diseases in which cytokines are dysregulated and for which pharmacological intervention targets immune cells.

Helicobacter pylori is not a determinant factor of persistent diarrhoea or malnutrition in Peruvian children

To investigate the role of Helicobacter pylori in childhood diarrhoea, specific IgG antibodies to H. pylori (determined by an ELISA) were sought in 119 infants aged 3-36 months in Peru. Thirty one of the infants had acute diarrhoea (defined as lasting < 72 h and not present in the previous 3 weeks), 67 had persistent diarrhoea (lasting > or = 14 days with no more than 1 intervening diarrhoea-free day) and the remaining 21 had not had diarrhoea in the previous 3 weeks. The children with diarrhoea had been admitted to hospital in Lima for diarrhoea treatment, and the diarrhoea-free children for investigation of possible tuberculosis. Aspirates of duodenal contents and duplicate stool samples were investigated for the presence of bacterial overgrowth and of pathogenic bacteria, viruses and parasites. Anthropometric measurements were also made. There were no statistically significant differences between the prevalence rates of IgG against H. pylori in the children with acute diarrhoea, persistent diarrhoea and without diarrhoea (32%, 43% and 29%, respectively). In addition, H. pylori infection (as evidenced by specific antibodies) had no apparent influence on the presence of small-bowel overgrowth (in 20% of seropositive children compared with 18% of seronegative children) or of pathogens in the stool (in 53% of seropositive children compared with 49% of seronegative children) or on the occurrence of malnutrition in the groups of children considered as a whole. We conclude that H. pylori infection is not associated with acute or persistent diarrhoeal disease, small-bowel overgrowth, stool pathogens or malnutrition in Peruvian children.

Association between a defective CCR-5 gene and progression to disease in HIV infection

We measured the effect(s) of CCR-5 genotype on disease progression by studying the frequency of a defective CCR-5 delta32 allele within a cohort of long-term infected individuals. An elevated frequency of CCR-5 delta32 heterozygotes within the cohort compared with a control population of blood donors was observed. An association between progression rate and CCR-5 delta32 heterozygosity was observed. Furthermore, analysis of proviral DNA V3 sequences from a subset of the cohort predicted that the majority of individuals (39 of 44) were infected with viruses predicted to utilize the beta-chemokine receptor CCR-5. The marked association between CCR-5 genotype and disease progression observed in this study may be a consequence of the predicted low frequency of CXCR-4-utilizing viruses present within the selected cohort.

Use of Roche AMPLICOR Mycobacterium tuberculosis PCR in early diagnosis of tuberculous meningitis

Several nucleic acid-based amplification tests are available for the detection of Mycobacterium tuberculosis, but few data are available on their use in the diagnosis of tuberculous meningitis (TBM). We performed a prospective study to assess the Roche AMPLICOR Mycobacterium tuberculosis PCR test (TB AMPLICOR) for use in the diagnosis of TBM and compared it with direct Ziehl-Neelsen staining of smears, radiometric culture for M. tuberculosis, and clinical and cerebrospinal fluid (CSF) findings. Eighty-three CSF specimens collected from 69 patients with suspected meningitis in South Africa were tested by TB AMPLICOR. On the basis of clinical and laboratory findings, 40 of these patients were treated for TBM and 29 patients were not treated for TBM. Ten CSF samples from 10 patients were positive by TB AMPLICOR. Seven of these 10 patients were classified as having definite TBM, 2 were classified as having probable TBM, and 1 was classified as having possible TBM. The sensitivity of TB AMPLICOR for detecting cases of definite and probable TBM in patients from whom CSF specimens had been collected less than 10 days into antituberculosis treatment was 60.0%. Specimens from all 29 patients not treated for TBM were negative by the TB AMPLICOR, giving a 100% specificity. TB AMPLICOR is therefore more sensitive than the combination of Ziehl-Neelsen staining of smears and radiometric culture for M. tuberculosis and is a rapid and highly specific diagnostic test for TBM.

Relationship between serum alkaline phosphatase and pyridoxal-5'-phosphate levels in hypophosphatasia

1. Hypophosphatasia is a disorder characterized by low serum levels of alkaline phosphatase (ALP) and a range of skeletal deformities. The levels of a number of phosphorylated metabolites, namely phosphoethanolamine and pyrophosphate, are characteristically raised. Levels of pyridoxal-5'-phosphate (PLP) have also been reported to be raised. 2. Hypophosphatasia is a rare disease and experience of measuring PLP in patients is lacking. We have had the chance to look at PLP levels in four families with hypophosphatasia, specifically to examine the quantitative relationship between ALP and PLP which has not been described before. 3. We confirmed that PLP levels are raised in hypophosphatasia and related to the disease severity. A significant negative linear relationship was found between the log PLP and log ALP (log PLP = 5.99-2.76 log ALP; r = -0.85, P < 0.001). 4. Measurement of PLP is simpler than some of the phosphorylated compounds, e.g. pyrophosphate. PLP may be a useful measure in patients with a suspected diagnosis of hypophosphatasia or for screening family members to detect potential heterozygotes and to monitor any response to therapy. 5. There did not appear to be any adverse clinical effects in relation to disturbed vitamin B6 metabolism in hypophosphatasia. 6. Vitamin B6 is used therapeutically in a number of conditions with monitoring of PLP levels. In these conditions PLP levels should be interpreted in conjunction with the prevailing serum ALP levels as the metabolism of these compounds is closely inter-related.

Herpesvirus saimiri-immortalized human T-cells support long-term, high titred replication of human immunodeficiency virus types 1 and 2

Herpesvirus saimiri strain C488 transforms human CD4+ T-lymphocytes to continuous interleukin-2-dependent growth. Unlike human T-cell lines derived from tumours or those transformed by human T-lymphotropic virus 1, herpesvirus saimiri-immortalized T-cells (HVS T-cells) retain many functions of primary activated T-lymphocytes. We have characterized the course of human immunodeficiency virus types 1 and 2 (HIV-1/-2) infection in three HVS T-cell lines. Our results confirm that HVS T-cells are highly permissive to both HIV-1/-2 prototype viruses and to poorly replicating HIV-2 strains of restricted cell tropism. However, the infection was persistently productive for up to 5 months. The down-regulation of surface CD4 molecules was delayed and virus yields significantly exceeded those obtained in T-cell lines.

Safety, immunogenicity, and excretion pattern of single-dose live oral cholera vaccine CVD 103-HgR in Peruvian adults of high and low socioeconomic levels

Groups of 122 Peruvian adults of low socioeconomic level (SEL) and 125 of high SEL received a randomly allocated 5 x 10(9)- or 5 x 10(8)-CFU dose of CVD 103-HgR live oral cholera vaccine or a placebo. The vaccine was well tolerated. Vibriocidal seroconversions occurred in 78% of high-SEL and 72% of low-SEL subjects who ingested the high dose and in 78 and 49%, respectively, of those who received the low dose.

Epidemiology of non-intentional injuries in an Australian urban region: results from injury surveillance

Injury surveillance provides an opportunity to determine non-intentional injury rates for those injuries which are treated in hospital accident and emergency departments. The first full calendar year of injury surveillance in north-western greater Melbourne was used to calculate incidence rates of a wide range of injury types and causes for 1989. In a population at risk estimated to number 150,604 children aged 0-14 years, the all-cause injury mortality was 10.5/100,000 per year (95% confidence interval [Cl], 5.4-15.8). There were 8207 attendances by children from the denominator area for non-intentional injury at the three hospitals participating in surveillance, representing rates of 6437/100,000 per year (95% Cl, 6258-6616) and 4406/100,000 per year (95% Cl, 4254-4558) for boys and girls respectively, while the rates for admission to hospital were 957/100,000 per year (95% Cl, 888-1025) and 649/100,000 per year (95% Cl, 590-707). The leading causes of hospital attendance were related to injuries involving sports, play equipment, bicycles and poisoning. These rates are substantially lower than those reported from other countries. The possible reasons for this include differences in health care utilization, under-ascertainment of cases, and a real difference in injury risk. Injury Surveillance Information System codes are defined for a standard set of injuries and injury causes which may be used for future comparative studies. Problems related to assessing the reliability of injury ascertainment are discussed, and the importance of integrating injury surveillance into routine hospital information systems is emphasized.

An investigation of Japanese subjects maps susceptibility to type 1 (insulin-dependent) diabetes mellitus close to the DQA1 gene

Insulin-dependent diabetic and control subjects of Japanese origin were HLA-DRB1, -DQB1, and -DQA1 typed using restriction fragment length polymorphism analysis and sequence-specific oligonucleotide gene probing. The DQA1 allele DQA1*0301 was positively associated with the disease [48/52 (92%) diabetic patients versus 44/64 (69%) control subjects, Pc less than 0.03, RR = 4.97]. Alleles of the DRB1 and DQB1 genes showed no significant association with the disease. The frequency of DQB1 genotypes encoding the amino acid aspartic acid at position 57 of the DQ beta chain did not differ significantly between subjects with insulin-dependent diabetes mellitus (IDDM) and controls. These findings suggest that a susceptibility allele for IDDM in the Japanese is more closely associated with the DQA1 gene than the DQB1 gene.

Finger injuries to children involving exercise bicycles

OBJECTIVE

A previously unreported source of injuries to children, the exercise bicycle, is identified and the associated injuries and their treatment are described.

DESIGN

A retrospective review of clinical records and the records of the Victorian Injury Surveillance System.

SETTING

The Plastic Surgery Unit of the Royal Children's Hospital, Parkville, Victoria.

PATIENTS

Seventeen children with finger injuries from exercise bicycles presented to the Emergency Department of the hospital and one presented to one of us (K L M) at his private practice. Sixteen of the 18 children were under five years of age; 10 were less than two years of age. Five times as many boys as girls were injured.

INTERVENTIONS

Fourteen children required surgical treatment of their injuries.

RESULTS

Four children had superficial injuries not in need of surgical repair. Eleven children had single digit injuries--five had injuries that were repaired by suture; five had complete avulsion of the tip of the digit that required flap graft repair; and one child underwent amputation of the index finger. Three boys had multiple digit injuries, each one requiring the amputation of a digit and repair of other digits. Two of these boys underwent replantation of a digit; only one replantation was successful.

CONCLUSIONS

The most dangerous parts of the exercise bike were the wheel, the chain and the sprocketwheel. Design modifications and education of parents about the risks for children playing near exercise bikes are warranted.

Detection of Giardia lamblia antigen in children living in a Peruvian periurban shantytown (Pueblo Joven)

Stool microscopy and an enzyme-linked immunosorbent assay (ELISA) for Giardia lamblia antigen detection were compared for detecting G. lamblia in 30 Peruvian infants. Of 1,131 fecal specimens, G. lamblia was detected by ELISA alone in 44, by microscopy alone in 17, and by both methods in 91. In another group of 17 children negative for G. lamblia by stool microscopy, 6 had G. lamblia detected by ELISA or duodenal aspiration: 2 only by ELISA, 1 only by duodenal aspirate examination, and 3 by both examinations. The ELISA is useful for the detection of G. lamblia in fecal specimens but compared to stool microscopy does not significantly increase the detection of cases.

Excavation at Newton, Islay

Summary

Excavations at Newton have revealed three phases of land use. Mesolithic activity was restricted to small flint working and domestic sites. A Neolithic phase appears to relate to a fragile soil resource which rapidly declined in quality. The final phase, possibly related to a Christian Irish presence on the island, occurs late in the sequence.

Mycoplasma pneumonia, Stevens-Johnson syndrome, and chronic obliterative bronchitis

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